title: Modifications of the ABCD2 score do not improve the risk stratification of transient ischemic attack patients.
abstract: BACKGROUND
  Modifications to the age, blood pressure, clinical symptoms, duration of symptoms, and diabetes (ABCD2) score, which incorporate history of hypertension and acute hyperglycemia in addition to acute blood pressure (BP) elevation and history of diabetes, have been proposed to increase the predictive value of the score. In addition, the timing of acute BP measurement may be important in the emergency department (ED) setting, given the phenomenon of "ED triage hypertension".
  
  
  METHODS
  The standard ABCD2 score was compared to modified scores incorporating various combinations of acute BP elevation or hyperglycemia, history of hypertension or diabetes, and subsequent versus initial ED BP measurements. The number of patients reclassified into an alternate risk category (low/moderate/high) with different schemes was determined. Predictive value using the composite outcome of stroke, death, or high-risk transient ischemic attack mechanism was assessed using c statistics.
  
  
  RESULTS
  Modified ABCD2 scores resulted in few patients shifting risk categories (between 2% and 10% for six alternate schemes), and did not improve the performance of the ABCD2 score (c-statistics, 0.61-0.65, compared to 0.63 for the standard score). ED triage hypertension was frequent (mean systolic blood pressure [SBP]/diastolic blood pressure [DBP] decrease of 8/9 mm Hg on subsequent measurement; P < .001), but the use of second BP did not reclassify many patients (10%) nor did it improve score performance (c-statistic, 0.61).
  
  
  CONCLUSIONS
  Modifications of the ABCD2 score changed the risk category for few patients and did not improve the overall predictive value of the score.
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Raser
authors.forename: Brett L
authors.initials: BL
authors.lastname: Cucchiara
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D048909:Diabetes Complications / Q000175:diagnosis; D006305:Health Status Indicators; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D015143:Philadelphia; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors